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change in receptor numbers, receptor affinity to drug, post receptor alterations, impairment of homeostatic mechanisms

What mechanisms explain different pharmacodynamics (altered drug response) in the elderly?

less (agonists and antagonists)

Elderly are ____ (more or less) sensitive to the effects of beta adrenergic stimulation

decreased baroreceptor reflex (homeostatic mechanism)

Why are elderly more susceptible to orthostatic hypertension when taking CV drugs?

FALSE (increased)

TRUE/FALSE - elderly have a decreased hypotensive and decreased heart rate response to CCBs (amlodipine and verapamil)

orthostatic hypertension, decreased beta sensitivity, increased risk torsades, increased hypotension and heart rate response to CCBs (start medications SLOWLY)

What risks do seniors face concerning CV drugs and effects?

TCA, antipsychotics, loop diuretics, direct vasodilators and opioids

What other medications cause orthostatic hypotension in the elderly?

MORE (use lower doses)

Geriatric patients are _____ sensitive to the effects of drugs that gain access to the CNS

short acting (lorazepam and oxazepam)

What types of benzodiazepines should be used in the elderly?


Elderly have ___ # of cholinergic neurons

increased (breaks down Ach more)

Elderly have ____ acetylcholinesterase


Elderly have ____ # of dopamine type 2 receptors


Elderly have ____ dopamine and dopaminergic neurons in the substantia nigra

anticholinergics (diphenhydramine and many others with AC side effects)

___ can cause mental confusion, memory impairment and delirium in the elderly

glaucoma, incontinence, BPH, constipation (in addition to CNS effects and delirium)

Besides confusion what other effects do anticholinergic medications have on the elderly?

anticholinergic potency

How likely an anticholinergic drug is to cause AC side effects is known as the _____

anticholinergic load

How many anticholinergic meds a patient is taking at one time is known as the ____

REPLACE, REDUCE, TIMING (replace the AC agents with highest potency, reduce dose, take at appropriate times)

If an elderly patient has a high ARS (anticholinergic Risk scale score) what should be done?

antihistamines, muscle relaxants, antiparkinson, antispasmodic, antipsychotic, hypnotic, antidepressants, antiarrhythmics

What classes of drugs have significant anticholinergic side effects?

dehydration, hyponatremia, hyperkalemia and prerenal azotemia

What fluid and electrolyte risks do elderly face on a diuretic?


Glucose tolerance ____ with age

FALSE (lower, meaning more bleeding)

TRUE/FALSE - elderly experience higher levels of vitamin K dependent clotting factors

multiple diseases, polypharmacy, atypical disease presentation

What are the factors that make lab values even more difficult to interpret in the elderly?

isoniazid, levodopa, morphine, vitamin C, nalidixic acid, penG

What drugs may lead to a positive urine glucose result?


What drug may produce a spurious increase in serum bilirubin and uric acid leading to false positive results?

FALSE (slight decrease - usually due to malnutrition or hospitalization)

TRUE/FALSE - elderly have an increase in serum albumin

FALSE (high BG because of declining glucose tolerance)

TRUE/FALSE - elderly without diabetes will have lower bloodsugar than normal

declining renal function

Uric acid rises minimally with age due to ____


Triglyceride values ____ in elderly


Vitamin b12 values ____ in elderly


Total cholesterol values _____ in elderly

PPIs, metformin (monitor for b12 in these patients)

What drugs can lead to an increase in vitamin b12?

INCREASE (investigate Paget's, it's not always osteoporosis)

Alkaline Phosphatase values _____ in elderly

TRUE (CrCl decreased by 10ml/min/decade)

TRUE/FALSE - SCr may be normal in elderly patients with a decreased CrCl

drug (caused)

Hyponatremia in the elderly is usually due to _____


Hypernatremia in the elderly is usually due to _____

decrease (15% between 30 and 80)

Serum magnesium values ____ in the elderly

PPI therapy

Acutely, a low Mg level is probably due to ____

INCREASES (high values indicated neoplasm, infection, or rheumatic disease)

ESR (inflammatory marker) _____ in the elderly

higher (hypothyroidism if TSH is above 10)

TSH is ____ in the elderly

prostate cancer, increases

PSA indicates ____ and the value ___ in elderly

FALSE (low HGB and HCT levels cannot be ascribed to aging alone - find the underlying cause)

TRUE/FALSE - elderly generally have low HGB and HCT levels

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